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Leg lengthening.

The combined experience of the Royal Hospital for Sick Children, Glasgow and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry in lengthening 52 lower limb segments with the Orthofix device is reviewed. Forty-eight segments were lengthened by callotasis, 24 in patients with achondroplasia. Attempted lengthening with chondrodiatasis was performed in 4 patients with leg length discrepancy. With callotasis, planned lengthening was achieved in 43/48 (90%) of segments. There was a small number of significant complications. Angulation or buckling of the new bone was the commonest major complication, and was seen in 10% of segments. Pin tract infection was the predominant minor complication. Premature union was noted commonly in the femurs of achondroplastics, but could usually be overcome with manipulation under anaesthesia. We confirm that callotasis achieves its objectives with fewer complications and operations than the commonly used Wagner method which it should supersede. By contrast, we had major complications in all cases with chondrodiatasis and have abandoned this method.

Adolescent↗

Early experience with leg lengthening by callotasis and chondrodiastasis.

Over a four year period, 20 segments in 16 patients were treated by lengthening by callotasis or chondrodiastasis. The indications for treatment were leg length discrepancy in 13 patients and short stature in three. Patients with leg length discrepancy were all treated by femoral lengthening; the mean length gained was 4.4 cm (range 2.5 to 6.Ocm). For patients with short stature, the mean femoral length gain was 10.0 cm (9.0 to 10.5 cm), and the mean tibial length gain was 8.0 cm (6.5 to 9.0 cm). The commonest problem was pin tract infection, but this always settled with antibiotic therapy. Most other complications were also successfully dealt with, and did not compromise the outcome of treatment. At the time of review, 13 of the 16 patients said they were very happy with the result; two patients were reserving judgement until completion of treatment, and, only one thought the treatment had been of no benefit. Our initial experience, with callotasis in particular, has been that it is a highly satisfactory method of limb lengthening, has an acceptable complication rate, and involves minimal hospitalization as compared with older techniques.

Adolescent↗

Experimental observations on the effects of leg lengthening by the Wagner Method.

A proximal tibial epiphysiodesis was successfully performed on the right hind legs of 23 young lambs, producing an average shortening of 12% of the total length of the tibia. A lengthener was attached to stainless steel pins which were then tapped into the shortened tibia prior to osteotomy. In 16 of the 23 animals it was possible to lengthen the shortened bone at a rate of 0.5 mm twice daily until the discrepancy was corrected. The gait was normal in most of the animals, all had full knee motion with no thigh atrophy, and 16 had limited hock (ankle) joint motion. Lengthening of the tibia by more than 11% consistently produced muscle changes in the leg and cartilage damage in the hock (ankle) joint. Any malalignment of the tibial fragments during lengthening intensified these changes.

Animals↗

Leg lengthening.

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Bone Lengthening↗

[Vascular bed of a lymph node and lymphodynamics after leg lengthening by the G. A. Ilizarov method].

In the experiments performed on dogs, the right shin has been elongated, lymph movement has been studied in the extremity, as well as in the arteries of the popliteal and medial iliac lymph nodes. The lymph movement rate immediately after fracture decreases 6 times, and during the elongation process it gradually restores with normalization on the 14th day of distraction. The integrity of the arterial bed in the lymph node is not disturbed during the elongation process of the shin. The intraorganic bed of the regional lymph nodes reacts to the shin elongation by increasing diameter of the arteries and the number of the functioning vessels. The changes in the arterial bed demonstrate an acceleration of the blood stream in the lymph nodes under the elongation of the shin. After osteogenesis normalization in the lymph stream takes place.

Animals↗

Comparison of different methods of leg lengthening.

Corticotomy according to Ilizarov was used for the treatment of congenital leg length discrepancies from June 1984 to June 1986. A comparison of the results of this method and previously performed methods has been made.

Bone Lengthening↗